Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome
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Background/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography(ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendrastent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreaticstrictures with a 6-Fr cystotome. Methods: A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant toconventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricturewith plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae. Results: Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis,with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and onehad a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the mostcommon location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limitingbleeding, whereas another patient developed mild post-ERCP pancreatitis. Conclusions: The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreaticstrictures after the failure of conventional modalities.
Abstract
Background/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography(ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendrastent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreaticstrictures with a 6-Fr cystotome. Methods: A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant toconventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricturewith plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae. Results: Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis,with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and onehad a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the mostcommon location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limitingbleeding, whereas another patient developed mild post-ERCP pancreatitis. Conclusions: The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreaticstrictures after the failure of conventional modalities.
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